The overall aim of this project is to evaluate the safety and immunogenicity of 3 different dosing options of trivalent influenza vaccine (TIV) vaccination of HIV-infected pregnant women: single dose, double dose (at same time point) and two-doses (1 month apart).

Further study details as provided by University of Witwatersrand, South Africa:

Primary Outcome Measures:

Number of participants who mount an adequate immune response one month post vaccination to a double dose compared to single dose of TIV [ Time Frame: One month (28-35 days) post vaccination ] [ Designated as safety issue: No ]

Determine the sero-response rate to each of the vaccine viral strains, defined as post vaccination hemagglutination inhibition (HAI) levels of ≥1:40 AND ≥4 fold increase over baseline HAI levels, in HIV-infected pregnant women receiving a double strength TIV dose compared to mothers receiving a single dose of TIV one-month after completion of the dosing schedule.

Determine the sero-response rate to each of the vaccine viral strains, defined as post vaccination HAI levels of ≥1:40 AND ≥4 fold increase over baseline HAI levels, in HIV-infected pregnant women receiving two-doses of TIV spaced 21-35 days apart compared to women receiving a single dose of TIV one-month after completion of the dosing schedule.

Number of participants in each treatment arm who have local and/ or systemic reactions post vaccination with TIV [ Time Frame: One week post vaccination ] [ Designated as safety issue: Yes ]

Evaluate the safety of the three dosing schedules of TIV in HIV-infected pregnant women vaccinated between 12-36 weeks of gestational age.

Secondary Outcome Measures:

Number of infants born to mothers who received double- or two doses of TIV who are seroprotected against influenza compared to infants born to mothers in single dose arm. [ Time Frame: Within first week of life (0-7 days) ] [ Designated as safety issue: No ]

Compare the proportion of newborns born to HIV-infected mothers in the double dose and two-dose arms with HAI antibody titers of ≥1:40 to each of the three TIV strains to newborns of HIV-infected and HIV-uninfected women (enrolled in separate parallel cohort) who received single dose of TIV.

Number of infants with protective maternal antibody levels against TIV at birth and at 8, 16 and 24 weeks of age [ Time Frame: Birth to 24 weeks post delivery ] [ Designated as safety issue: No ]

Determine the kinetics of transplacental transfer of maternal Hemagglutinin (HA) antibodies and persistence thereof until 24 weeks post-partum in the infants.

Number of infants born to women in double- and two dose TIV arms, compared to single TIV dose arm who are protected against laboratory confirmed influenza [ Time Frame: Birth to 24 weeks ] [ Designated as safety issue: No ]

Compare the relative efficacy of a double-strength or two-dose dose TIV schedule compared to a single dose TIV schedule in pregnant HIV-infected women in protecting against laboratory-confirmed influenza illness in their infants up to 24 weeks of chronological age.

Number of infants born to women in double- and two- dose TIV arms compared to single dose arm who are protected against clinical influenza like illness [ Time Frame: Birth to 24 weeks post delivery ] [ Designated as safety issue: No ]

Compare the relative efficacy of a double-strength or two-dose dose TIV schedule compared to a single dose TIV schedule in pregnant HIV-infected women in protecting against protocol defined clinical influenza like illness (ILI) in their infants up to 24 weeks of chronological age.

Number of women protected against laboratory confirmed influenza in each treatment arm [ Time Frame: From date of vaccination (12 to 36 weeks gestational age [GA]) until infant is 24 weeks old. Anticipated mean GA at randomisation is 20 weeks, and at delivery is 39 weeks, so average follow up period is 43 weeks, however it could be as long as a year. ] [ Designated as safety issue: No ]

Compare the relative efficacy of a double-strength or two-dose dose TIV schedule compared to a single dose TIV schedule in pregnant HIV-infected women in protecting against laboratory-confirmed influenza illness in maternal participants up to 24 weeks post partum.

Number of women protected against clinical influenza like illness in each treatment arm [ Time Frame: From date of vaccination (12 to 36 weeks gestational age [GA]) until infant is 24 weeks old. Anticipated mean GA at randomisation is 20 weeks, and at delivery is 39 weeks, so average follow up period is 43 weeks, however it could be as long as a year. ] [ Designated as safety issue: No ]

Compare the relative efficacy of a double-strength or two-dose dose TIV schedule compared to a single dose TIV schedule in pregnant HIV-infected women in protecting against protocol defined clinical ILI in maternal participants up to 24 weeks post partum.

Number of women who mount immune responses (seroconversion /seroprotection)in each treatment arm [ Time Frame: From date of vaccination (12 to 36 weeks gestational age [GA]) until infant is 24 weeks old. Anticipated mean GA at randomisation is 20 weeks, and at delivery is 39 weeks, so average follow up period is 43 weeks, however it could be as long as a year. ] [ Designated as safety issue: No ]

Number of women who have changes to CD4+ and/ or viral load results post vaccination in each treatment arm [ Time Frame: From date of vaccination (12 to 36 weeks gestational age [GA]) until infant is born. Anticipated mean GA at randomisation is 20 weeks, and at delivery is 39 weeks, so average follow up period is 19 weeks, however it could be as long as 30 weeks. ] [ Designated as safety issue: Yes ]

Evaluate the effect of TIV (single, double and two doses) on CD4+ cell count and HIV-viral load changes comparing baseline levels to levels at delivery.

Number of participants in each treatment arm who suffer adverse pregnancy outcomes (maternal or foetal) after TIV-vaccination [ Time Frame: From date of vaccination (12 to 36 weeks gestational age [GA]) until infant is born. Anticipated mean GA at randomisation is 20 weeks, and at delivery is 39 weeks, so average follow up period is 19 weeks, however it could be as long as 30 weeks. ] [ Designated as safety issue: Yes ]

A B/Brisbane/60/2008-like virus * A/Wisconsin/15/2009 and A/Victoria/210/2009 are A/Perth/16/2009-like viruses for use in the 2012 Southern Hemisphere winter. This vaccine is the same as the vaccine used for the 2011 Southern hemisphere influenza season.

Other Name: Vaxigrip

Biological: Normal saline

0.5ml normal saline will be used as 'placebo' vaccine to maintain blinding

Other Name: NaCl

Experimental: Double dose TIV

Trivalent Influenza vaccine (seasonal) Two doses will be administered at enrolment

A B/Brisbane/60/2008-like virus * A/Wisconsin/15/2009 and A/Victoria/210/2009 are A/Perth/16/2009-like viruses for use in the 2012 Southern Hemisphere winter. This vaccine is the same as the vaccine used for the 2011 Southern hemisphere influenza season.

Other Name: Vaxigrip

Biological: Normal saline

0.5ml normal saline will be used as 'placebo' vaccine to maintain blinding

A B/Brisbane/60/2008-like virus * A/Wisconsin/15/2009 and A/Victoria/210/2009 are A/Perth/16/2009-like viruses for use in the 2012 Southern Hemisphere winter. This vaccine is the same as the vaccine used for the 2011 Southern hemisphere influenza season.

Other Name: Vaxigrip

Biological: Normal saline

0.5ml normal saline will be used as 'placebo' vaccine to maintain blinding

Gestational age greater or equal 12 weeks to under 36 weeks documented by the approximate date of the last menstrual period and corroborated by physical/ sonar examination.

Documented to be HIV-infected on two assays prior to study-enrolment.

Able to understand and comply with planned study procedures.

Provides written informed consent prior to initiation of study.

Exclusion Criteria:

Features of WHO clinical category 3 or 4 of AIDS at the time of enrolment.

Receipt of TIV, other than through the study, during the current influenza season documented by medical history or record.

Receipt of any live licensed vaccine 28 days or less or inactivated licensed vaccine (EXCEPT tetanus toxoid) 14 days or less prior to study-vaccine.

Receipt of a non-licensed agent (vaccine, drug, biologic, device, blood product, or medication) 28 days or less prior to vaccination in this study, or expects to receive another non-licensed agent before delivery unless study approval is obtained.

Any significant (in the opinion of the site investigator) acute illness and/or oral temperature greater than or equal to 38 degrees Celcius ≤ 24 hours prior to study entry.

Use of anti-cancer systemic chemotherapy or radiation therapy ≤ 48 weeks of study enrollment, or has immunosuppression as a result of an underlying illness or treatment.

Long term use of glucocorticoids, including oral or parenteral prednisone ≥ 20 mg/day or equivalent for more than 2 consecutive weeks (or 2 weeks total) ≤ 12 weeks of study entry, or high-dose inhaled steroids (>800 mcg/day of beclomethasone dipropionate or equivalent) ≤ 12 weeks before study entry (nasal and topical steroids are allowed).

Receipt of corticosteroids for preterm labor ≤ 14 days before study entry.

Receipt of immunoglobulin or other blood products (with exception of Rho D immune globulin) ≤ 12 weeks prior to enrollment in this study or is scheduled to receive immunoglobulin or other blood products (with the exception of Rho D immune globulin) during pregnancy or for the first 24 weeks after delivery.

Any condition that would, in the opinion of the site investigator, place the subject at an unacceptable risk of injury or render the subject unable to meet the requirements of the protocol.

Pregnancy complications (in the current pregnancy) such as pre-term labor, hypertension (BP >140/90 in the presence of proteinuria or BP >150/100, with or without proteinuria or currently on antihypertensive medication) and pre-eclampsia.

Contacts and Locations

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Please refer to this study by its ClinicalTrials.gov identifier: NCT01527825

Locations

South Africa

Respiratory and Meningeal Pathogens research unit

Soweto, Johannesburg, Gauteng, South Africa, 2013

Sponsors and Collaborators

University of Witwatersrand, South Africa

Investigators

Study Chair:

Shabir A Madhi, MD PhD

University of the Witwatersrand

More Information

No publications provided

Responsible Party:

Michelle Groome, Senior medical officer, University of Witwatersrand, South Africa